What should I expect on my first visit?
Upon your first visit, you will be greeted by our friendly caring staff.
After check in and completion of paperwork, you be directed to our radiology department. We perform x-
rays on all new patients or pre-existing patients with a new complaint. X-rays are an incredibly beneficial
tool when assessing patient’s orthopedic problems. After you visit our radiology department, you will then
be guided to one of our exam rooms where you will be evaluated by Dr. Bramlett.
What are alternatives to surgery?
Although we are an orthopedic surgical practice, we pride ourselves on offering
our patients nonsurgical options when applicable. We start with “Pre-habilitation,” Pre-habilitation includes
weight management strategies, NSAID therapy, and most importantly, self-guided physical therapy.
What is the process for surgery prep?
Our surgical preparation includes acquiring pre-surgical clearances from your
cardiologist or primary care physician if you have a history of heart attack, stents, pacemakers, atrial
fibrillation, or are on blood thinners. You should avoid any joint injections or dental procedures for 3
weeks prior to surgery. Also, certain medications need be stopped before surgery, please see the
Medications to stop section for a list of important medications to stop and how long before surgery you
should stop them. You will also have to visit the Pre-admission Testing office at the hospital to obtain
clearance for surgery. In the days or weeks leading up to surgery, Dr. Bramlett wants you working on the
prescribed exercises to get your body ready for the procedure. You should also speak with family and
friends to ensure that you have the appropriate support post-operatively.
What should I expect the day of surgery and afterwards?
You will be notified in the days leading up to surgery as to what time to arrive at the hospital. Upon arrival, you will meet with hospital staff and will be taken back to the pre-operative holding area; your family/friends will be allowed to accompany you during this time. While you are in pre-op, Dr. Bramlett will come and see you before you are taken back for surgery, as will his nurse practitioner and/or nurse.

For Day Procedures: You will spend a few hours in the Post-Anesthesia Care Unit following your procedure. You will be released home with the appropriate medications and post-surgical directions when

For Over-night Stay Procedures: After the procedure, you will spend approximately 1-2 hours in the Post-Anesthesia Care Unit, then will be moved to a hospital room. The average patient stay is only one night in the hospital for either a knee replacement or hip replacement; occasionally patients will require a 2 or 3-night stay.

How does self-guided therapy work?
During your hospital stay the hospital physical therapists will guide you through the
exercise series that we utilize. Physical therapy and occupational therapy clearances are required before we will discharge you from the hospital. After discharge, you will only be required to complete the physical therapy exercises that we prescribe, they are self-guided. Seldomly, organized physical therapy is prescribed for patients. If Dr. Bramlett feels that you are not progressing as you should be by your two weeks follow up appointment, he may prescribe a few weeks of physical therapy.
What are the post-operative medications?
Our post-operative medication regimen is simple, we strive to keep it as
simple and effective as possible.

  • Acetaminophen/Oxycodone (Percocet) or Acetaminophen/Hydrocodone (Norco) for painmanagement.
  • Aspirin or Eliquis for prevention of deep vein thrombosis. If you are currently on blood thinners, you will resume them after surgery.
  • Methocarbamol (Robaxin) helps alleviate muscle spasms.
  • Gabapentin (Neurontin) to prevent/treat nerve pain.
  • Zofran/Phenergan for the prevention of nausea and vomiting.
What are some post-operative non-medication interventions I could utilize?

In addition to the medication prescribed above, Dr.
Bramlett advises that you also utilize non-medication methods of pain management. These methods

  • The prescribed exercises. -We want you to work hard, but don’t over do it.
  • Cold -use ice or devices such as the Gameready.
  •  Elevation -get your affected extremity above your heart using devices such as pillows, the backs
    of couches, or headboards of beds.
  • Compression – utilize the ACE wrap provided to you upon discharge or purchase a smaller one from the local pharmacy. Wrap you extremity snug, but not too tight.
When should I schedule my post-op follow up?

This is dependent upon the surgery that you had performed, but for total joint replacement procedures you will return to the clinic within 10-14 days of your

When can I start driving?

How long after surgery that you can start driving is dependent on what procedure you have had performed, which extremity is affected, and how long you are under the influence of narcotic pain medication. If your right leg is unaffected and you are no longer requiring narcotic pain medication,
you can start driving within 3-5 days of surgery.

What if my leg swells after surgery?

Post-operative swelling is a very common occurrence after a total hip or knee replacement. Generally, the swelling starts the day after surgery and persists for many days. Swelling is part of the healing process and is normal. The exercises that will be provided to you will help to reduce
swelling as quickly as possible. For knee or shoulder replacements, immediately after surgery, you will be fitted for a Gameready cooling device that you will use throughout your hospital stay. You will also have the option of taking it home with you for use as long as you need it. The Gameready helps reduce post-operative pain and swelling significantly. Most patients start the Gameready
immediately and have been able to discontinue the use of pain medications sooner. The use of an ACE compression wrap is often advised to assist in reducing post-operative swelling.

Despite the swelling, we do still want you to complete the exercises that are found in your pre-operative surgical packet. The exercises are also discussed with you during your wait time in pre-op
and before discharge. To help alleviate swelling, we recommend that you elevate the extremity aswell as use of ice or the Gameready device.

If the swelling does not subside substantially over the first several days with the aforementioned interventions, or you notice redness and heat, or coolness present in your operative leg you should
contact Dr. Bramlett’s office.

What if I have swelling in my arms or shoulders after surgery?

After a shoulder arthroscopy or total shoulder replacement, swelling in the shoulder, elbow, wrist and hand is common. Gameready devices are available for the shoulder as well and provide optimal swelling and pain relief. Post-operative exercises are provided for shoulder rehabilitation as well.

Should I expect bruising after surgery?

Yes, some amount of bruising is to be expected after surgery. The amount of bruising is dependent on many factors and varies from person to person. Some will only experience redness around their
incisions; others will have various amounts of bruising on their operative extremity. Both are considered normal and will resolve over the next 10-14 days.

What should I expect my activity level to be?

Every patient is different. Every day you should be increasing your activity level but let your pain level and swelling be your guide. You will make 90 percent of your recovery in the first four to six weeks, and the remaining ten percent will come within the next 6 months to a year.

At some point, some patients overdo their activities; therefore, taking a few steps back in their recovery; you may have increased swelling or discomfort if this happens. You only need to become concerned if you cannot control your pain with rest, ice, and pain medications, or if you have
difficulty bearing weight through your surgical extremity.

Is there a limit to how much weight I can put on my operative extremity?

You can put as much weight as you can tolerate on your surgical leg immediately after surgery. You will be weight bearing before you leave the hospital. The physical therapists at the hospital will work
with you on weight bearing exercises and techniques to aid in your mobility during the immediate post-operative recovery phase. You will likely require a walker for 3-7 days post-operatively, at which point you can transition to a cane for a few days. By your follow up appointment in 10-14 days you should be walking with a cane or a walking stick, many patients can walk into the clinic unaided
at this time.

When can I shower or bathe?

You can shower the day after surgery. We advise all patients that they should refrain from bating or getting into a pool for 12-14 days after surgery, but showering is okay; this is to reduce the risk of infection. If any scabs are present after 12-14 days, you may not get into a pool or bathe until fully

Can I use a hotub to help with pain?

Not immediately, no. Due to the heat and the bacteria present in the water, we do not want you touse a hot tub or whirlpool for at least six weeks. Once again, this is to reduce the chance of you getting an infection.

How long do I have to wear the stockings?

You should wear them for two weeks. During the two weeks you must wear the stockings during the day, but may remove them at night. These should be worn on both legs after surgery until you come
back to the clinic for your follow-up appointment. The stockings serve two functions, they provide compression to assist with swelling and they provide further DVT prophylaxis.

When can I restart the meds I was told to stop prior to surgery?

Usually the day after surgery, but check with Dr. Bramlett’s office if there are any medications in question.

Now that I am no longer requiring narcotic pain medication, what can I take if I should experience discomfort?

You may take Tylenol or Extra-Strength Tylenol coupled with ibuprofen (Advil) or naproxen (Aleve).

What should I do if I think my joint is infected?

You will experience some bruising and swelling after surgery. In addition, you may
notice a small amount of yellowish or pinkish drainage. You should contact the office if you have a large amount of drainage that has saturated through your clothing, if the drainage is yellowish/cloudy or if you are running a consistent temperature of 101.5 F, or if you have a new
onset of pain that is not controlled by your pain medications. These symptoms do not mean that you are infected but are symptoms we should be notified of.

What should I do to avoid constipation?

The use of narcotic pain medication can cause constipation. Two to three days prior to surgery you should start taking an over the counter stool softener, such as Colace or Senokot to help prevent constipation. If you experience constipation during your recovery, you can use over the counter
Miralax or Magnesium Citrate, which should provide you with relief. You should do this until you start having normal bowel movements.

My knee clicks, is that normal?

Clicking after surgery is a common occurrence and is often noticeable immediately after surgery. It is made worse by the swelling associated with the procedure; as the swelling decreases the clicking should be come less noticeable.

What medications should I stop prior to surgery?
  • Aspirin – 10 days
  • Plavix, Eliquis – 7 days
  • NSAIDS (such as Mobic, Lodine, Celebrex, or Indocin), Vitamin K – 7 days
  • Coumadin – 5 days
  • Pradaxa – 2-4 days
Should I take antibiotics for any other procedures? For how long? Who prescribes them?

If you have any artificial implants, such as knee, hip, or shoulder you should be placed on prophylactic antibiotics before having any dental procedures, including teeth cleanings.

If you are having any invasive procedures and are unsure if you should be on antibiotics, please call
the office. If you are having the above procedure, please contact the office to obtain the antibiotic from Dr. Bramlett. You will receive either Amoxicillin or Clindamycin for patients with penicillin
allergies. Please do not schedule any of the above appointments within 4 weeks of surgery or up to 3 months after surgery. Antibiotic treatment is a lifelong precaution.

When should I call the office

Dr. Bramlett would like for you to call the office if any of the following conditions occur:

  • Fever > 101.5 degrees F that doesn’t respond to Tylenol
  • Pain not controlled with medications
  • Increased drainage or swelling
  • Inability to bear weight
  • Swelling in the operative foot or calf that is accompanied by coolness or decreased sensation in foot
  • Confusion or disorientation.